- Clinical Professor of Neurosurgery, School of Medicine, State University of NY at Stony Brook, NY and ℅ Dr. Marc Agulnick 1122 Frankllin Avenue Suite 106, Garden City, NY 11530, USA.
Nancy E. Epstein, MD, Clinical Professor of Neurosurgery, School of Medicine, State University of NY at Stony Brook, NY and ℅ Dr. Marc Agulnick 1122 Frankllin Avenue Suite 106, Garden City, NY 11530, USA.
DOI:10.25259/SNI_170_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Nancy E. Epstein. Review/Perspective: Operations for Cauda Equina Syndromes - “The Sooner the Better”. 25-Mar-2022;13:100
How to cite this URL: Nancy E. Epstein. Review/Perspective: Operations for Cauda Equina Syndromes - “The Sooner the Better”. 25-Mar-2022;13:100. Available from: https://surgicalneurologyint.com/surgicalint-articles/11490/
Background: Although most studies recommended that early surgery for cauda equina syndromes (CES) be performed within
Methods: The 2 major variants of CES include; incomplete/partial ICES, and those with urinary retention/bowel incontinence (RCES). Those with ICES often exhibit varying combinations of motor weakness, sensory loss (i.e. including perineal numbness), and urinary dysfunction, while RCES patients typically exhibit more severe paraparesis, sensory loss including saddle anesthesia, and urinary/bowel incontinence. The pathology responsible for ICES/RCES syndromes may include; acute disc herniations/stenosis, trauma (i.e. including iatrogenic/ surgical hematomas etc.), infections, abscesses, and other pathology. Surgery for either ICES/RCES may include decompressions to multilevel laminectomies/fusions.
Results: Following early surgery, most studies showed that ICES and RCES patients exhibited improvement in motor weakness and sensory loss. However, recovery of sphincter function was more variable, being poorer for RCES patients with preoperative urinary retention/bowel incontinence.
Conclusions: Although early CES surgery was defined in most studies as
Keywords: Cauda Equina Syndrome, Early Diagnosis, Optimal Timing, Surgery, “The Sooner the Better” Surgery
Surgery performed “the sooner the better” for patients with cauda equina syndromes (CES) was best [
Multiple studies confirmed that the red flags for CES (i.e. including ICES and RCES syndromes) included; varying severities of sciatica, motor weakness, sensory loss with reduced perineal sensation, bladder/bowel dysfunction/urinary retention, and loss of sexual function [
Most smaller studies recommended early surgery for CES (ICES/RCES) within <48 h. [
Several studies observed greater residual long-term bladder or bowel dysfunction after surgery in both ICES and RCES patients [
The medicolegal literature acknowledges that CES surgery performed “the sooner the better” is best [
Although many studies stated that CES surgery should be performed within <48 h. after symptom onset, two of the largest NISC series (i.e. involving 20, 924,[
Patient’s consent not required as there are no patients in this study.
There are no conflicts of interest.
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